目的

探究腹腔镜下Nissen胃底折叠术、Toupet胃底折叠术在食管裂孔疝合并胃食管反流病（GERD）患者中的应用观察。

方法

回顾性分析2022年4月至2023年4月收治的食管裂孔疝合并GERD患者的临床资料，按照手术方法不同，将患者分为Nissen组（行Nissen胃底折叠术）与Toupet组（行Toupet胃底折叠术），依照倾向性匹配法（卡钳值0.02）排除患者基线资料混杂因素，每组各得53例基线资料可比（P>0.05）患者。统计学分析软件SSPS21.0分析整合数据，计数资料用［例（%）］表示，行χ²检验与秩和检验；计量资料用（）表示，采用独立样本t检验。P<0.05为差异有统计学意义。

结果

两组患者术中出血量、手术时间、首次排气时间、引流管拔除时间、住院天数均无明显差异（P>0.05）；Toupet组患者并发症总发生率显著低于Nissen组（P<0.05）；术后6个月，两组患者反流次数、反流时间及胃食管反流评分（GERD-Q）评分显著降低（P<0.05），且Nissen组反流次数与反流时间显著低于Toupet组（P<0.05），而组间GERD-Q差异不显著（P>0.05）；术后6个月，两组食管下括约肌压力（LESP）、完全松弛压力（IRP）显著提高（P<0.05），食管远端收缩积分（DCI）显著降低（P<0.05），而组间差异均不显著（P>0.05）；术后，Toupet组患者营养状态显著优于Nissen组（P<0.05）。

结论

Nissen与Toupet胃底折叠术均可有效治疗食管裂孔疝合并GERD，Nissen胃底折叠术在改善反流方面更优，Toupet胃底折叠术术后并发症更少，临床可根据实际情况选择手术类型。

Objective

To explore the application of laparoscopic Nissen fundoplication and Toupet fundoplication in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease (GERD).

Methods

The clinical data of patients with esophageal hiatal hernia complicated with GERD admitted from April 2022 to April 2023 were retrospectively analyzed. According to different surgical methods, the patients were divided into the Nissen group (undergoing Nissen fundoplication) and the Toupet group (undergoing Toupet fundoplication). Confounding factors in the baseline data of the patients were excluded by the propensity score matching method (caliper value 0.02), and 53 patients with comparable baseline data (P>0.05) were obtained in each group. The statistical analysis software SSPS21.0 was used to analyze and integrate the data. Enumeration data were expressed as［ cases (%)］, and χ² test and Rank Sum test were performed; Measurement data were expressed as (), and independent sample t tests were performed. P<0.05 was considered to indicate a statistically significant difference.

Results

There were no significant differences in intraoperative blood loss,operation time, first exhaust time, drainage tube removal time, and length of hospital stay between the two groups of patients (P>0.05); The incidence of complications in the Toupet group was significantly lower than that in the Nissen group (P<0.05); Six months after the operation, the number of reflux episodes, reflux time, and gastroesophageal reflux disease questionnaire (GERD-Q) scores of the patients in both groups were significantly decreased (P<0.05), and the number of reflux episodes and reflux time in the Nissen group were significantly lower than those in the Toupet group (P<0.05), while there was no significant difference in GERD-Q scores between the groups (P>0.05); Six months after the operation, the lower esophageal sphincter pressure (LESP)and integrated relaxation pressure (IRP) of the patients in both groups were significantly increased (P<0.05),and the distal esophageal contractile integral (DCI) was significantly decreased (P<0.05), while there were no significant differences between the groups (P>0.05); After the operation, the nutritional status of the patients in the Toupet group was significantly better than that in the Nissen group (P<0.05).

Conclusion

Both Nissen fundoplication and Toupet fundoplication can effectively treat esophageal hiatal hernia complicated with GERD.Nissen fundoplication is superior in improving reflux, and Toupet fundoplication has fewer postoperative complications. Clinically, the type of surgery can be selected according to the actual situation.